Nocturia and obstructive sleep apnoea

Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes. In this Review, the authors provide urologists and other interested physicians with an improved understanding of the multifactorial pathophysiology underlying the correlation between obstructive sleep apnoea and nocturia. They describe current evidence, identify topics for future research, and provide practical recommendations for managing patients with this complex condition. Nocturia in obstructive sleep apnoea (OSA) is a complex problem and has a multifactorial aetiology.Treatment with continuous positive airway pressure can reduce nocturnal urine volume and nocturia in some patients with OSA.The commonly held theory attributing polyuria to a false signal of cardiac overload and a response natriuresis is too simplistic.Further research is needed to improve understanding of the effects of OSA on the autonomic nervous system, oxidative stress and endothelial damage.Clinicians need to be aware of the potential effect of OSA on physiology and to refer patients for further testing at a sleep centre.Effective management of nocturia in OSA requires a multidisciplinary approach, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle.